Once older people were considered wise because of their life experiences and the knowledge gained over a long life. But that is changing because of the speed at which the world is now evolving.
Hanging over all of this is the specter of fear brought on by speedy growth of various forms of dementia, of which Alzheimer’s is the most common form.
Dr. Carroll Haymon, director of the Geriatric Fellowship Program at Swedish Medical Center, said she wonders how relevant people’s experiences are today.
“My grandfather died recently at the age of 96, and we were thinking about the changes that have happened [since] he was born in rural Louisiana,” Haymon said.
Life then was about the same as human beings had been living for the last 500 years, she said, but between the early 20th century and the early 21st century, life has largely changed.
“So his experiences became less relevant as he got older because he didn’t know how to use an iPhone and he didn’t know how to use e-mail. There were all kinds of things that he couldn’t do that had become more relevant,” she said.
Dr. Jerold Mikszewski, a neurologist at the Pacific Medical Centers’ clinics at Beacon Hill and Northgate, said it is a matter of learning.
“Whether one has grown wiser or not in the context of aging can perhaps be better viewed as whether one has aged successfully or not. Scientific studies looking at this issue have found that the key element to successfully aging relates to whether one has learned how to successfully approach solving a problem,” he said.
Dementia and old age
Because more people are living longer means more are being diagnosed with some form of dementia.
“If we didn’t have many people who lived past the age of 85, then we wouldn’t see as many cases,” said Haymon of Swedish. “One in eight Americans over the age of 65 have Alzheimer’s or another dementia, but by the time we get people over 85, it is almost half the people who have it.”
While it is often thought that fewer offspring take care of elderly parents now than in the past, Haymon doesn’t agree.
“An incredible number of people today do still take care of their parents or family members, even when those family members have dementia. The numbers are staggering,” she said.
But she added it has become more acceptable to put people into supervised settings.
“I think that has to be part of the reality, because once people really have dementia, which doesn’t just mean that they are old, it means that they are very impaired,” Haymon said.
Instead of older people being ignored, often the real problem is they get too much high-cost medical care. “What I see is sometimes, those people are still subject to exactly the same kind of very aggressive medical care that you would subject a 40-year-old to,” she said.
That care likely will do no good for those suffering from dementia, but it will drive up the costs of care to patients and to society.
“Death rates have gone down from heart disease, they have gone down from stroke, they’ve gone down from HIV, they’ve gone down from cancer, [but] they have increased from dementia,” she said. “They survive their heart attack at 50 because we have amazing technology. Now they survive their stroke at 60, and then they live long enough to develop a dementia illness that ultimately limits their life span, but not until they are up into their 80s.”
Haymon said, “it is really important” for people to have the conversation with their doctors about medical care for those with dementia because “we have the capacity in this country to provide extraordinary levels of care, which is great if you are an 18-year-old in a motor vehicle accident, or if you are a 50-year-old who has a heart attack and has probably about 30 good years ahead of you.”
Haymon added, “It is a progressive disease: It is going to be worse next year than it is this year, and it is going to be worse in three years and that you are not going to live more than five years, typically. Therefore, what kind of care do you want in that time?”
No cure or treatment
“There is no treatment that makes any difference,” Haymon said. “That was the confirmed finding of the National Institutes of Health panel last year that looked at all the evidence, all the treatments, and they concluded there is nothing that can be done to prevent it and there is nothing that can be done to treat it.”
Haymon said there is ongoing research, so there is hope for the future.
Is the fear of Alzheimer’s and other forms of dementia causing people to worry more every time they cannot remember something quickly?
“Studies have been done in stroke that show that people fear disability much more than they fear death,” Mikszewski said. “With dementia, you become cognitively disabled. You cannot think of what you want to say and cannot follow what others are saying to you. You forget what has happened or what has been said. You forget how to do things, such as use the telephone or operate appliances. Bills may go unpaid. Some individuals become lost even in familiar surroundings. Others may forget how to cook or whether they have eaten of not. Eventually, you cannot care for yourself at all.”
Haymon says uncertainty about dementia may cause needless worry.
“I do think that it can be hard for people to tell the difference in the minor memory loss that can come with aging,” she said. “There are changes that occur naturally to our brains with aging that can be difficult for people to distinguish between that and the more concerning changes that might be hallmarks of dementia.”
That person should see his or her doctor, but there is also help on the Internet.
The not-for-profit Alzheimer’s Association provides resources, and Haymon said “they have some great on-line resources and support groups” listed on its website, like how a person can know if they should be worried.
She said getting information on how to diagnose dementia is an “active area” area now, Haymon said.
“My belief is that we need to do a better job educating primary-care doctors to be able to make the diagnosis [of dementia],” Haymon said.
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